The purpose of this conference is to convene leading educators, clinicians, and researchers to articulate and clarify challenges presented by a rapidly changing delivery system. A critical issue, and the central focus of the conference and follow-up dissemination efforts, is patient referrals from primary to specialty care. The objective is to stimulate the development of educational models to guide future physicians as well as the development of an agenda for practice and public policy. By focusing primarily on educational and practice issues, and secondarily on issues related to research and policy, this conference offers an essential complement to AHCPR's research program on the interface between primary and specialty care. The goals are: 1) To bring together generalists and specialists to develop principles that will define the optimal relationship between generalists and specialists and to develop strategies for navigating the primary care-specialty care interface, effectively. Educational strategies will be a central focus, but areas where additional research is essential to guide future practice, education and policy will also be identified. 2) To bring together primary care physicians and experts in the doctor-patient relationship to examine emerging issues in this relationship that are unique to managed care settings, and to discuss how to teach about them. For example, how can young physicians be taught to anticipate and manage patient expectations for specialty care and fears that appropriate care will be denied? 3) To assess issues related to the physician and the organization in a managed care setting, and to develop strategies to teach physicians about their new roles in these relationships. That is, how can young physicians be taught to manage the expectations of multiple "customers" (ie., patients, health plans, other colleagues) effectively? The Society of General Internal Medicine's Task Force on Managed Care, in collaboration with the Society of Teachers of family Medicine, the American Academy on Physician and Patient, and ASP is planning the conference.